阿德福韦酯联合拉米夫定治疗慢性乙肝和肝硬化致肾损害的特点及处理探讨(1)
[摘要] 目的 觀察阿德福韦酯(ADV)联合拉米夫定(LAM)治疗慢性乙肝(CHB)和肝硬化(LC)患者出现肾性低磷血症等不良反应的临床特点，探讨换用恩替卡韦(ETV)治疗后的效果。 方法 选取2012年1月～2018年3月在山东省淄博市中心医院应用LAM治疗出现耐药后加用ADV联合治疗(add-on方案)的患有CHB和LC(Child-Pugh A级)的患者例行检查，若发现低磷血症等肾脏不良反应，则作为研究对象，并及时停用ADV和LAM;将轻、中度CHB患者作为A组，换用ETV 0.5 mg/d。将重度CHB和LC患者作为B组，采用ETV 1.0 mg/d治疗。采用配对资料的Wilcoxon符号秩和检验进行统计分析。 结果 低磷血症等肾损害发生在add-on方案治疗63(49，71)个月后，换用ETV治疗后，生化指标和症状逐渐改善;换药治疗6个月后两组血鳞、eGFR与换药前比较，差异有统计学意义(P < 0.05);两组换药前后血磷、eGFR比较，差异无统计学意义(P > 0.05);所有患者换药后血HBV DNA仍低于检测下限。 结论 长期应用ADV联合LAM治疗，部分CHB和LC患者可出现低磷血症等不良反应，及时停药、换用ETV可改善病情，且维持抗病毒的效果。
[关键词] 阿德福韦酯;恩替卡韦;低磷血症;肝炎;乙型;慢性
[中图分类号] R512.62;R575.2 [文献标识码] A [文章编号] 1673-7210(2019)07(b)-0164-04
Characteristics and treatment of Adefovir Dipivoxil combined with Lamivudine in the treatment of renal damage caused by chronic hepatitis B and cirrhosis
LI Xinwen1 FAN Yuchen2 XING Yanqing1 LU Yujuan1 HAN Liyan2 ZHANG Xiuhua1
1.Department of Infectious Diseases， Zibo Central Hospital， Shandong Province， Zibo 255036， China; 2.Department of Hepatology， Qilu Hospital of Shandong University， Shandong Provence， Ji′nan 250015， China
[Abstract] Objective To observe the clinical characteristics of Adfovir Dipivoxil (ADV) combined with Lamivudine (LAM) in the treatment of chronic hepatitis B (CHB) and liver cirrhosis (LC) patients with renal hypophosphatemia and other adverse reactions， and to explore the efficacy of Entecavir (ETV) treatment. Methods From January 2012 to March 2018， patients with CHB and LC (Child-Pugh A grade) who were treated with LAM and ADV combined therapy (add-on scheme) after drug resistance in Zibo Central Hospital of Shandong Province were selected for routine examination. If adverse renal reactions such as hypophosphatemia were found， ADV and LAM were discontinued in time. Patients with mild or moderate CHB were selected as group A and replaced with ETV 0.5. Mg/d. Patients with severe CH B and LC were treated with ETV 1.0 mg/d as group B. Wilcoxon sign rank sum test of paired data was used for statistical analysis. Results Renal damage such as hypophosphatemia occurred after 63 (49， 71) months of add-on regimen treatment， and the biochemical indexes and symptoms gradually improved after ETV treatment. There were significant differences in blood scales and eGFR between the two groups after 6 months of drug change (P < 0.05). There was no significant difference in blood phosphorus and eGFR between the two groups before and after drug change (P > 0.05). Blood HBV DNA was still below the detection limit in all patients after dressing change. Conclusion Patients with CHB and HBV-related liver cirrhosis may develop hypophosphatemia and other adverse reactions after a long-term add-on therapy. Switching to ETV can reduce adverse effects and maintain the efficacy in inhibiting HBV replication., 百拇医药(李新文 范玉琛 邢延清 鲁玉娟 韩利岩 张秀华)
[关键词] 阿德福韦酯;恩替卡韦;低磷血症;肝炎;乙型;慢性
[中图分类号] R512.62;R575.2 [文献标识码] A [文章编号] 1673-7210(2019)07(b)-0164-04
Characteristics and treatment of Adefovir Dipivoxil combined with Lamivudine in the treatment of renal damage caused by chronic hepatitis B and cirrhosis
LI Xinwen1 FAN Yuchen2 XING Yanqing1 LU Yujuan1 HAN Liyan2 ZHANG Xiuhua1
1.Department of Infectious Diseases， Zibo Central Hospital， Shandong Province， Zibo 255036， China; 2.Department of Hepatology， Qilu Hospital of Shandong University， Shandong Provence， Ji′nan 250015， China
[Abstract] Objective To observe the clinical characteristics of Adfovir Dipivoxil (ADV) combined with Lamivudine (LAM) in the treatment of chronic hepatitis B (CHB) and liver cirrhosis (LC) patients with renal hypophosphatemia and other adverse reactions， and to explore the efficacy of Entecavir (ETV) treatment. Methods From January 2012 to March 2018， patients with CHB and LC (Child-Pugh A grade) who were treated with LAM and ADV combined therapy (add-on scheme) after drug resistance in Zibo Central Hospital of Shandong Province were selected for routine examination. If adverse renal reactions such as hypophosphatemia were found， ADV and LAM were discontinued in time. Patients with mild or moderate CHB were selected as group A and replaced with ETV 0.5. Mg/d. Patients with severe CH B and LC were treated with ETV 1.0 mg/d as group B. Wilcoxon sign rank sum test of paired data was used for statistical analysis. Results Renal damage such as hypophosphatemia occurred after 63 (49， 71) months of add-on regimen treatment， and the biochemical indexes and symptoms gradually improved after ETV treatment. There were significant differences in blood scales and eGFR between the two groups after 6 months of drug change (P < 0.05). There was no significant difference in blood phosphorus and eGFR between the two groups before and after drug change (P > 0.05). Blood HBV DNA was still below the detection limit in all patients after dressing change. Conclusion Patients with CHB and HBV-related liver cirrhosis may develop hypophosphatemia and other adverse reactions after a long-term add-on therapy. Switching to ETV can reduce adverse effects and maintain the efficacy in inhibiting HBV replication., 百拇医药(李新文 范玉琛 邢延清 鲁玉娟 韩利岩 张秀华)